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02060126-FP(C C RTY ®IF COUP ERTIINO CU���F P EIMIIT ATP LIIC ATEON IFORM APN # . . -aj -i 1 ° Q — D i 0 Date: 3ta�xe - -2-10'02 Building Address: ff p -1 o D Owner's Name: Phone #; Contractor: License M Contact: I� l�� C G Phone C��) AL� t Applican Contractor: t Fax #: Building Permit Info: Bldg Elect Plumb Mech Job Description: Residential: Cam Re-Feje. Sq.Ft. Floor Ar --%s $/S Architec ngmeer: {� f j,/� �1 I �+ tvt `v Val ation: Type of Construction: Occupancy Group: BCONSTAXH lz U Quantity Fee ID Fee Description Fee (Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V < =1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BlEN1ERGY Energy BUR LdDUNG BENERGYADD EnergyAddMulti BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi - Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 Ura If ter �u�rxaafvv BUILDING DIVISION PERMIT (CONTRACTOR !NFO D MA7 BUIL ) Es 9 OHNSON AVE. PERMIT N (02 O 6 012 6 OWILMUI!fE:SON LIN APPLICATIetGYI 06Y 20 0 2 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH C 0 0 LICENSED CONTRACTOR'S DECLARATION m P 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing F Z Q with Section 7000) of Division 3 of the Businessand Professions Code, and my license is f < h in full force and effect. O'z License Class Lic. N Z H a Date Contractor ARCHITECTS DECLARATION Zz < I understand my plans shall be used as public records XOWQ ut 3 C. F- Licensed Professional H H < OWNER- BUILDER DECLARATION 1 hereby aff nm that 1 am exempt from the Contractor's License law for the lu Cc � 0 O following mason. (Section 7031.5, Business and Professions Code: Any city or county a ae $ which requires a permit to construct, alter. improve. demolish. or repair any swcture FZ y prior to its issuance, also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 z r (commencing with Section 7000) off)ivision 3 of the Business and Professions Code) or y $ that he is exempt therefrom and the-basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for i permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for purpose of al. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contra or such projects with a contractor(s) licensed pursuant m the Contractor's License ❑ I am a pt under Sec. , B &o f9r 7 rePaptf Owne Dalk ereby �A�OPENSATIONDECII��ATI "m under penalty of perjury one of the mg declarations: ❑ IhaveandwillmaintainaCertificateofConsent toself-insure forWorketsCompen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not becompleted if the permit is Intone hundred dollars ($100) or less.) 1 certify that in the performancepf the work for w14' ch this rmrt is issued, I shall not employ any pee ?,n in any man r rtokSpeq s bZos t.Workcrs' Compensation Laws of Cali6brfijia. Date, fill ICE �hswh (af( is ng this Certificat e of Exemption, you should come Compensation provisions of the Labor Code, you must 0 forthwith comvisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY [-r H 1 hereby affirm that there is a construction lending agency for the performance of LY the work for which this permit is issued (Sec. 3097, Civ. C.) WG1. Q Lender's Name Z Lenders Address V 0 1 certify that 1 have read this application and state that the above information is UL correct. 1 agree to comply with all city and county ordinances and state laws relating to 0 F" building construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. W (We) agree to save, indemnify and keep harmless the City of Cupertino against 04 En liabilities, judgments, costs and expenses which may in any way accrue against said City C) Z in consequ a of the granting of this pe roil. APPLIC U%JN-.DERSTAN S AND WILL COMPLY WITH ALL NON -POINT S old'eO.N, A--I /,0 '---a HAZARDOUS MATERIALS DISCLOSURE Will a applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes u ve read the hazardous materials requirements under Chapter 6.95 of the Califor- niaH Ith Safety Codc,Sations2505, 25533 and 25534.1understand that ifthe building d no urtently have a tenant at it is my responsibility m notify the occupant of the re erp� wjficn� pssuance of a Certific 0=2 attf�y. Date NEW SINGLE FAB TV?esf509t1ING LIVING SPACE 2158 SQ.FT. GARAGE 438 SQ.FT. Sq. Ft. Floor Area 5 O 'gil"tion Occupancy Type 102 - PIERS Required Inspections 103 - UFER 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310 - INTERIOR LATH 311 - SCRATCH COAT 313 - ROOF NAIL 501 - FINAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY 505 - FINAL ELECTRICAL 506 - GAS TEST 507 - FINAL PLUMBING 5 FINAL MENICAL 09 FIN ReMfi 5 ` NIssued by. ORKS Date Re -roofs 603 - OF BATTENS Type of %6f4 - ROOF IN-PROGRESS All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPEKI'INO BUILDING DIVISION PERMIT KSON TRA CTORaINF,ORMATION :_ BUIL c. l US OHN SON AVE. PERMIT N ®2060126 .PAT9,Iyr.SON LIN APPLICAT©bS11 9aQ�2 �02 lI __�� ONE: SANITARY NO. CONTROL NO. ARZHITECT /ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECII 0 0 0 0 j LICENSED CONfRACTOR'SDECLARATION 1 hereby (form that 1 am licensed under provisions of Chapter 9 (commencing i NEW 7 s SINGLE FAA'I� � ffff�itING ;who stchnnngwnar Division 3m are Business and Pure :shmscade.awmy uanst i my [term. in lull force and effect. LIVING SPACE 2158 SQ. FT. License Clasp Lic. X Date Commerce GARAGE 438 SQ.FT. ARCHITECTS DECLARATION I stn.. esmnd my plans shall be used as public records / , ' Licensed Prolcxsinnal j OWNER - BUILDER DECLARATION 1 hereby that 1 m wool from the Cecoonsol License Law for the i reaso . (SteL 1. c Professions Ctde: Any city or county fiID3strct. , which requires Permit aftexsand which)ash (permit Ire after, tit requires the forsuh Permit t alogedtatemare + that he itsiensedf alsentto the provisions of for Connector's Lice se Law(Chaplem that LicenseLaw(Chapter9 Sq. Ft. Floor Area $3508d1tiLtion (commencing Division me cing with Section abprovisionsmtheCnnwcess of the Business Coin of 3 that exempt pth therefrom anBil is tempt thcmfrom and o or base for the moon. Any vi exemption. Any violation of io t, Section or subjects the by any applicant fora permit suM1jcas the applicant m a civil penalty of C Occupancy Type than not more than five hundred dollars (SSCg). I, as owner of the properly, or my employees with wages as their sole compensation. will do the work, and the swcture is not installed proffered fmsale (Sec. 7044, Business and Professions Code: The Contractive, License Law does not apply ha an owner or 10 2 - PIERS equtred Inspections property who builds or improves thereon, and who does such work himself or through his own employees. provided that such improvements are not intended or offered for sale. If, 103 — UFER however, the building or improvement is sold within one year of completion. the owner- 104 builder will have the burden of proving that he did not build or improve for puryox of — REBAR 105 — ANCHOR BOLTS I, as owner of the Propcny, ames musively contracting with licensed conmeara to 106 — SEWER & WATER comwm the pmjtn (ntL. 9844, Business and Professions Code:) The Contractors Li- nmLowdpee not apply to• nownerofprepitAywhoWildsorimpmo heeon .and 202 — UNDERFLOOR PLUMBING who eonm or such protest with a con uaetnr(s)littnudputsuam to arc GOnIrM10I's ucenatL 203 — UNDERFLOOR MECHANICAL ❑lame ptsenders«. B &/PCr'67s I 204 - UNDERFLOOR FRAME rte Dal— 205 - UNDERFLOOR INSULATION / < OMPENSATIONDECL An 301 — ROUGH PLUMBING Ihercby ism under penahy of perjury one of the mg dalaradnns 302 — TUB & OR SHOWER ❑ I have end will maintain a Cenificam nIConsent to self -insure for Worker's Compete sation, as provided for by Section 370f) of the labor Cate, for the performance of the 303 — ROUGH MECHANICAL work for which thisptrmitisissued. 304 — ROUGH ELECTRICAL ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 305 — FRAME 3700 of the labor Code. for arc performance of the work for which this permit is issued. My Workers rnmpcasaapn Insurance carrier and Policy number am 306 — HOLDOWNS Carrier: Policy No: 307 — INSULATION A1 E OF CERTIPICCOMPEN ATION E IINSURANORKF.RS' 308 — SHEETROCK (This sCClion Decd not he complcteJif the permit is fnronc hundred J011ats(SI(Xd 309 — EXTERIOR LATH arlcu') 310 — INTERIOR LATH 1 certify th t in the perharranceX the walk for w ch this t is issued. [.,halt nth employ any PC n nany mandrAu I�`pWnrkcri Compensation lDa, "�'YYffff''"" VV 311 — SCRATCH COAT ituMCn�srlrjlao Lawsof Cal' 'ice 313 — ROOF NAIL Ap is 501 — FINAL ELECTRICAL ENERGY ICE is ng this Ccnificateof Exemption, youshould a man Worker Comp nsalion prasdsmas of lalmr code. YOU must forthwith comply ve h such provisions or this permil shall he deemed revoked. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY I hereby affirm area there is a constrecom lending agency for the performancror 504 — FINAL BUILDING ENERGY ,he w k Name Lender's ework Na which this permit is issues (Sec. JlN9, Civ. CJ 505 506 — FINAL ELECTRICAL — GAS TEST Under, Address I «nify that 1 have read this application and state that the above mfamtadnn is 507 — FINAL PLUMBING correct. I agree m comply with all city and county oNinanecs and state laws relating to building conswction, and hereby authorize upesentruves of this city to enter upon the 5 FINAL MECHANICAL hovemetnioned properly for inspection purposes. (Wt) agree In cost. indemnify and keep harmless plc Cite against 0 9 FIN DE liabilitits,juigmcnB,cosst and expenses which may in anyway accmc against said City sector in atnscyu cofthc Framing nl this permit APPLIC 5 N G A / !VI`/ UNDF,RSTAN n AND WILL COMPLY WITH ALL NONPOINT ]SSUCd by51 WORKS DaIC 1/ 1 Y Re -roofs 603 — OF BATTENS o go c I p feanac, tut Dam IIAL RDOUSMATERIALSDISCLOSU Type Of%()f4 - ROOF IN- PROGRESS WIII cappreant nrfilm. Willing «eupam slareor handle her arJous material as deOned by the Cupertino Municipal Code. Chanter 9.12. and the Health still sstrm �dc. Section 25532hol N - - -_ -- ❑YU' Will the applicant or future building elcupam sere eyuipmtm nr devices which emit hamrdous air comamimen , as defined by the Bay Area Air Quality Management District? f / ❑Yes 'pG read U tewnt. Wilding n of or All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Dale All roof coverings to be Class "B" or better